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Biomedical subjects

T L Barrett

Publications and source records attributed to T L Barrett.

At least 19 recordsLinked to original sources
PubMed2000

Current concepts: the use of immunoperoxidase techniques in mohs micrographic surgery.

Mohs micrographic surgery is used for the removal of certain malignant tumors, both ensuring complete excision by histologic examination of margins as well as minimizing normal tissue loss. Recently, several investigators have incorporated the use of immunoperoxidase techniques to aid in the removal of selected high-risk carcinomas, sarcomas, and melanomas. We describe the basic principles of immunoperoxidase and review recent articles in which immunoperoxidase was used as an adjunct to routine hematoxylin-eosin staining in Mohs micrographic surgery. Additionally, we show examples of selected tumors comparing routine hematoxylin-eosin stains and immunoperoxidase. We believe the use of immunoperoxidase can be of significant value in the removal of certain high-risk tumors. In particular, this technique is useful in "unmasking" malignant cells in areas of dense inflammation, identification of some cases of perineural invasion, identification of pagetoid spread in carcinomas and melanomas, and finally in helping to identify subtle margins in dermatofibrosarcoma protuberans.

Carcinoma, Squamous Cell↗
PubMed1999

Nodular fasciitis: response to intralesional corticosteroids.

Nodular fasciitis is one of the more common soft-tissue lesions, frequently presenting as a rapidly enlarging subcutaneous mass on the arm. Management is usually surgical excision; however, large infiltrative lesions may be difficult to manage. We describe a patient in whom intralesional corticosteroid injections provided rapid resolution.

Adult↗
PubMed1999

Recognition and management of high-risk cutaneous tumors.

The majority of cutaneous malignancies can be treated by the military dermatologist in a clinical setting. Recognition of tumors at high risk for recurrence or metastasis is important for any dermatologist but especially list care. Providing optimal care includes knowledge about which patients should be medavacced to larger medical centers for advanced surgical and medical treatments.

Humans↗
PubMed1999

Intravascular angioleiomyoma.

A 59-year-old man presented with a 6-year history of a 2-cm tender nodule on his left lateral elbow. Excisional biopsy led to the diagnosis of angioleiomyoma. However, unlike typical angioleiomyoma which demonstrate extravascular extension, this lesion demonstrated purely intravascular growth.

Actins↗
PubMed1999

Immunohistochemical staining for Ber-EP4, p53, proliferating cell nuclear antigen, Ki-67, bcl-2, CD34, and factor XIIIa in nevus sebaceus.

Increased expression of p53 has been found in the majority of basal cell carcinomas (BCCs). The pattern and intensity of this staining, as well as staining for proliferation antigens, seems to correlate with behavior of histologic subtypes of BCC. Nevus sebaceus (NS) is considered a hamartoma. Multiple epithelial neoplasms do arise in NS, and, rarely, they show an aggressive biologic behavior. Significant numbers of these neoplasms, however, have areas of basaloid hyperplasia that are often reported as BCC. Although morphologically similar to BCC, the mechanism underlying the development of these areas has not been investigated, so we sought to evaluate the expression of Ber-EP4, p53, proliferating cell nuclear antigen, Ki-67, bcl-2, Factor XIIIa, and CD34 in areas showing basaloid hyperplasia, arising in NS. We performed immunohistochemical stains for Ber-EP4, p53, proliferating cell nuclear antigen, Ki-67, bcl-2, Factor XIIIa, and CD34 on seven cases of NS with areas of basaloid hyperplasia. All of the eight cases of NS showed diffuse positive membrane staining for Ber-EP4 and negative nuclear staining for p53. Proliferating cell nuclear antigen and Ki-67 staining was only slightly increased in the areas of basaloid hyperplasia, compared with the surrounding epidermis and with areas of the epidermis peripheral to the hamartomatous proliferation, and bcl-2 was only focally positive. Factor XIIIa-positive cells and CD34-positive vascular endothelial cells were increased within the subjacent dermis, a pattern suggestive of follicular differentiation. Our findings suggest that even though areas of basaloid hyperplasia in NS are morphologically similar to BCC, they are induced by different stimulatory and molecular mechanisms. These different mechanisms result in expression of immunohistochemical markers more characteristic of benign follicular tumors than of BCC.

Adolescent↗
PubMed1998

Is CD30 (Ki-1) immunostaining in cutaneous eruptions useful as a marker of Th1 to Th2 cytokine switching and/or as a marker of advanced HIV-1 disease?

CD30 is a member of the tumour necrosis factor/nerve growth factor receptor superfamily, which is expressed on CD4+ and CD8+ T-cell clones which produce T helper (Th) 2-type cytokines. It has been proposed that disease progression in HIV-1 is associated with Th1 to Th2 cytokine switching. In 70 cutaneous biopsies from HIV-1 positive patients in different stages of disease, we performed a battery of immunohistochemical stains. These included antibodies to CD3, UCHL-1, OPD-4, L-26, KP-1 and CD30 (Ki-1). In addition, we used a similar battery of stains on cutaneous biopsies of HIV-1 negative patients with inflammatory dermatoses which are established as Th1 or Th2 dominant, e.g. polar leprosy. CD30+ cells were rarely present in early stages of HIV-1 disease, but commonly present in later stages of disease. However, there were cases of late HIV-1 disease which did not contain CD30+ cells. Increased numbers of CD30+ cells were more commonly seen in later stages of HIV-1 disease. However, the expression of CD30 appeared to be better in predicting other established Th2 cutaneous infiltrates in HIV-1 negative patients than in predicting a Th2 cutaneous cytokine pattern in advanced HIV-1 disease.

Biomarkers↗
PubMed1998

A review of tumor suppressor genes in cutaneous neoplasms with emphasis on cell cycle regulators.

Cells normally have five options. These include renewal or proliferation, terminal differentiation, quiescence, senescence, and apoptosis. Many factors interact with cell cycle regulators to direct the cells toward these different options. Tumor suppressor genes play a pivotal role in this process. Alterations in these genes may limit the options that cells have and thus play a significant role in the multistep process of carcinogenesis. We will focus on tumor suppressor genes and especially tumor suppressor genes that interact directly with the cell cycle proteins.

Cell Cycle Proteins↗
PubMed1998

Umbilical pilonidal sinus.

Although most cases of pilonidal sinus occur in the sacrococcygeal region, umbilical presentations can occur. Due to risk of peritoneal extension of inflammation from this lesion, the umbilical pilonidal sinus should be treated more aggressively than its sacrococcygeal counterpart. Pilonidal sinus should therefore be included in the differential diagnosis of umbilical nodules.

Adult↗
PubMed1998

Blue rubber bleb nevus syndrome.

Blue rubber bleb nevus syndrome is a rare autosomal dominant disorder of multiple venous malformations of the skin and gastrointestinal tract. The fragility of the gastrointestinal lesions may lead to significant occult blood loss and subsequent anemia.

Diagnosis, Differential↗
PubMed1997

Immunohistochemical nuclear staining for p53, PCNA, and Ki-67 in different histologic variants of basal cell carcinoma.

BACKGROUND: Increased expression of p53 has been found in the majority of basal cell carcinomas (BCCs); however, UV-light-induced signature mutations are present in only about 50% of cases. Increased nuclear staining with an immunohistochemical marker of proliferation, proliferating cell nuclear antigen (PCNA), has been correlated with aggressive behavior in BCC. OBJECTIVE: Our purpose was to determine whether there is any relationship between different histologic variants of BCC and their expression of p53, PCNA, and Ki-67. METHODS: We used immunohistochemical stains for p53, PCNA, and Ki-67, in superficial-multicentric, nodular-noduloulcerative, sclerosing, infiltrative, and metatypical BCC, to determine whether the staining patterns differ in these different histologic variants of BCC. RESULTS: Superficial-multicentric BCCs were negative for p53 in four of eight tumors. Nodular BCC showed moderately intense p53 nuclear staining with some peripheral accentuation. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were fewer than 10% in nodular BCC. Sclerosing and infiltrative BCC showed intense p53 nuclear staining with peripheral accentuation. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were greater than 30% in the majority of these tumors. Metatypical BCCs showed diffuse intense p53 staining. PCNA nuclear staining was greater than Ki-67, and PCNA-positive cells were greater than 30% in all tumors studied. When overlying actinic keratoses showed p53 staining, the staining did not necessarily correlate with the intensity or even the presence of positive staining in the subjacent BCC. CONCLUSION: There are at least four distinctive patterns for staining of p53, PCNA, and Ki-67 that correlate with different histologic variants of BCC.

Biomarkers, Tumor↗
PubMed1996

Histologic and immunohistochemical features in biopsy sites in which bovine collagen matrix was used for hemostasis.

BACKGROUND: Bovine collagen matrix (Helistat and Helatene), which is used primarily for hemostasis, decreases wound contracture in skin biopsy sites and promotes wound granulation. OBJECTIVE: Our purpose was to evaluate excision specimens of previous biopsy sites to determine whether there are histologic differences between cases in which bovine collagen matrix was used for hemostasis and those in which it was not used. METHODS: Thirty-two diagnostic punch biopsies were done with hemostasis obtained with bovine collagen matrix in 24 biopsies and by pressure alone in eight. The biopsy sites were reexcised at various time intervals, and the histologic and immunohistochemical features were evaluated and compared. RESULTS: In specimens in which collagen matrix was used, migration of stromal and epithelial cells along the bovine collagen matrix was evident by 2 days and had progressed rapidly by 4 days. Around and within the matrix hyaluronic acid increased during the first 8 to 10 days. Initially stromal cells stained with CD34 and reticulum fibers were present at 8 to 10 days. AT 12 to 15 days, factor XIIIa+ stromal cells were present within the matrix, and host collagen fibers were present and well-oriented within the degenerating matrix. Biopsy specimens allowed to heal without the matrix showed a delayed and an uneven increase in hyaluronic acid. Furthermore, the granulation tissue within the dermis showed no organization with a persistent acute inflammatory infiltrate and increased muscle actin-positive stromal cells as scar formation proceeded. CONCLUSION: Bovine collagen products appear to provide a matrix that promotes thrombosis. The collagen matrix also promotes migration and attachment of stomal and epithelial cells, thereby organizing and accelerating wound healing.

Actins↗
PubMed1996

Cutaneous pseudosarcomatous polyp: a histological and immunohistochemical study.

Two unusual acquired polypoid skin lesions exhibited prominent histological atypia, but were biologically benign. Both patients were elderly females. The lesions clinically mimicked fibroepithelial polyp or nevus lipomatosus. Both had been present for about 20 years. One lesion was located on the back, the other on the posterior thigh. Each lesion exhibited dilated, hyalinized vessels in the dermis with focal fibrin deposits, myxoid stroma, and a population of bizarre, pleomorphic spindle to stellate cells, some of which were multinucleated. Occasional atypical mitoses were present. One lesion had abundant admixed fat. Immunohistochemical staining was strongly positive only for vimentin. The lesions share features with degenerating angiofibroma and vaginal pseudosarcomatous polyp. As in these lesions, the atypia is most probably reactive and degenerative.

Aged↗
PubMed1996

Ossifying fibromyxoid tumor of soft parts: a case report and review.

Ossifying fibromyxoid tumor of soft parts is a recently described, rare but morphologically distinctive tumor of soft tissue, including subcutaneous soft tissue. We report a case of ossifying fibromyxoid tumor of soft parts which occurred in the subcutaneous tissue of a 68-year-old male, and review the clinical, histologic, and immunohistologic features of this tumor. Ossifying fibromyxoid tumor of soft parts tends to occur in the subcutaneous tissue and have been reported from the head and neck, upper and lower extremities, and trunk. Immunohistologic studies have supported a neural origin. While considered benign, local recurrence after excision is common and these tumors should be excised with clear margins to prevent recurrence.

Aged↗